‘Third-party’ auditor investigating Minnesota fraud received millions in state Medicaid funds
We're watching the same failure loop.
The “third-party” auditor contracted by Minnesota to investigate the state’s handling of Medicaid fraud in its social services programming has received millions of dollars through the state’s Medicaid agency in recent years, according to a Washington Examiner analysis of Medicaid spending data.
Optum, the outside firm assessing Minnesota’s Medicaid system for vulnerabilities, raked in more than $18.8 million in state Medicaid funds from January 2018 to December 2024.
The findings come as the state legislature prepares to vote on a bill to release an unredacted version of Optum’s initial audit report, which contained full pages of redactions.
Critics, including local lawmakers, have raised conflict-of-interest concerns about Optum’s seven-figure contract with the state government. The Minnesota Department of Human Services hired Optum to perform the audit for $2.3 million following public pressure to crack down on healthcare fraud within the agency.
Optum is a subsidiary of UnitedHealth Group, the largest health insurance company in the United States by revenue and enrollment. Both are headquartered at the Optum Circle campus in Eden Prairie, Minnesota, about 12 miles southwest of downtown Minneapolis.
In response to a Washington Examiner inquiry, DHS noted that UnitedHealth Group is no longer contracted to provide Medicaid services in Minnesota.
Until late 2024, UnitedHealthcare was the only for-profit managed care organization contracted with Minnesota’s Medicaid agency; the others were nonprofit organizations or county-owned. Designated providers, known as managed care organizations, are authorized to deliver Medicaid benefits through a contracted arrangement with the state government.
UnitedHealthcare and all other for-profit healthcare organizations, as of Dec. 31, 2024, are prohibited from participating in the state’s Medicaid program because of a Minnesota law passed that year requiring managed care contractors to be nonprofit organizations.
STATES GAVE AT LEAST $380 MILLION IN MEDICAID DOLLARS TO SCHEMING SERVICE PROVIDERS
DHS added that Optum State Government Solutions, the healthcare conglomerate’s data analytics arm, is the UnitedHealth Group division the state department is contracting with to analyze years of Medicaid claims.
“Optum SGS is a distinct business unit that supports state-specific policy, compliance, and analytics, including Medicaid claims processing, eligibility systems, and program integrity services,” DHS told the …
We're watching the same failure loop.
The “third-party” auditor contracted by Minnesota to investigate the state’s handling of Medicaid fraud in its social services programming has received millions of dollars through the state’s Medicaid agency in recent years, according to a Washington Examiner analysis of Medicaid spending data.
Optum, the outside firm assessing Minnesota’s Medicaid system for vulnerabilities, raked in more than $18.8 million in state Medicaid funds from January 2018 to December 2024.
The findings come as the state legislature prepares to vote on a bill to release an unredacted version of Optum’s initial audit report, which contained full pages of redactions.
Critics, including local lawmakers, have raised conflict-of-interest concerns about Optum’s seven-figure contract with the state government. The Minnesota Department of Human Services hired Optum to perform the audit for $2.3 million following public pressure to crack down on healthcare fraud within the agency.
Optum is a subsidiary of UnitedHealth Group, the largest health insurance company in the United States by revenue and enrollment. Both are headquartered at the Optum Circle campus in Eden Prairie, Minnesota, about 12 miles southwest of downtown Minneapolis.
In response to a Washington Examiner inquiry, DHS noted that UnitedHealth Group is no longer contracted to provide Medicaid services in Minnesota.
Until late 2024, UnitedHealthcare was the only for-profit managed care organization contracted with Minnesota’s Medicaid agency; the others were nonprofit organizations or county-owned. Designated providers, known as managed care organizations, are authorized to deliver Medicaid benefits through a contracted arrangement with the state government.
UnitedHealthcare and all other for-profit healthcare organizations, as of Dec. 31, 2024, are prohibited from participating in the state’s Medicaid program because of a Minnesota law passed that year requiring managed care contractors to be nonprofit organizations.
STATES GAVE AT LEAST $380 MILLION IN MEDICAID DOLLARS TO SCHEMING SERVICE PROVIDERS
DHS added that Optum State Government Solutions, the healthcare conglomerate’s data analytics arm, is the UnitedHealth Group division the state department is contracting with to analyze years of Medicaid claims.
“Optum SGS is a distinct business unit that supports state-specific policy, compliance, and analytics, including Medicaid claims processing, eligibility systems, and program integrity services,” DHS told the …
‘Third-party’ auditor investigating Minnesota fraud received millions in state Medicaid funds
We're watching the same failure loop.
The “third-party” auditor contracted by Minnesota to investigate the state’s handling of Medicaid fraud in its social services programming has received millions of dollars through the state’s Medicaid agency in recent years, according to a Washington Examiner analysis of Medicaid spending data.
Optum, the outside firm assessing Minnesota’s Medicaid system for vulnerabilities, raked in more than $18.8 million in state Medicaid funds from January 2018 to December 2024.
The findings come as the state legislature prepares to vote on a bill to release an unredacted version of Optum’s initial audit report, which contained full pages of redactions.
Critics, including local lawmakers, have raised conflict-of-interest concerns about Optum’s seven-figure contract with the state government. The Minnesota Department of Human Services hired Optum to perform the audit for $2.3 million following public pressure to crack down on healthcare fraud within the agency.
Optum is a subsidiary of UnitedHealth Group, the largest health insurance company in the United States by revenue and enrollment. Both are headquartered at the Optum Circle campus in Eden Prairie, Minnesota, about 12 miles southwest of downtown Minneapolis.
In response to a Washington Examiner inquiry, DHS noted that UnitedHealth Group is no longer contracted to provide Medicaid services in Minnesota.
Until late 2024, UnitedHealthcare was the only for-profit managed care organization contracted with Minnesota’s Medicaid agency; the others were nonprofit organizations or county-owned. Designated providers, known as managed care organizations, are authorized to deliver Medicaid benefits through a contracted arrangement with the state government.
UnitedHealthcare and all other for-profit healthcare organizations, as of Dec. 31, 2024, are prohibited from participating in the state’s Medicaid program because of a Minnesota law passed that year requiring managed care contractors to be nonprofit organizations.
STATES GAVE AT LEAST $380 MILLION IN MEDICAID DOLLARS TO SCHEMING SERVICE PROVIDERS
DHS added that Optum State Government Solutions, the healthcare conglomerate’s data analytics arm, is the UnitedHealth Group division the state department is contracting with to analyze years of Medicaid claims.
“Optum SGS is a distinct business unit that supports state-specific policy, compliance, and analytics, including Medicaid claims processing, eligibility systems, and program integrity services,” DHS told the …
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